Impact of intravascular ultrasound-guided minimum-contrast coronary intervention on 1-year clinical outcomes in patients with stage 4 or 5 advanced chronic kidney disease
This study aims to elucidate 1-year clinical outcomes using this technique for patients with stage 4 or 5 advanced chronic kidney disease (CKD). Research has proven that imaging-guided percutaneous coronary intervention (PCI) reduces contrast volume significantly; however, only short-term clinical benefits have been reported. Minimum-contrast (MINICON) studies are based on the registry design pattern to enroll PCI results in patients with advanced CKD stage 4 or 5 comorbid with coronary artery disease. We excluded cases of emergency PCI or maintenance dialysis from this study. In this study, we compared the intravascular ultrasound (IVUS)-guided MINICON PCI group (n = 98) with the angiography-guided standard PCI group (n = 86). Enrollment of the MINICON studies started in 2006. Before 2012, IVUS-guided MINICON PCI was performed only in 14% (stage 1), but it was 100% after 2012 (stage 2). The enrollment finished in 2016. The IVUS-guided MINICON PCI group exhibited a significantly reduced contrast volume (22 ± 20 vs. 130 ± 105 mL; P < 0.0001) and contrast-induced acute kidney injury (CI-AKI; 2% vs. 15%; P = 0.001). The PCI success rate was similarly high (100% vs. 99%; P = 0.35). At 1 year (follow-up rate, 100%), we observed less induction of renal replacement therapy (RRT; 2.7% vs. 13.6%; P = 0.01), but all-cause mortality or myocardial infarction was similar in both groups. The IVUS-guided MINICON PCI reduces CI-AKI significantly and induction of RRT at 1 year in patients with stage 4 or 5 advanced CKD.
KeywordsCoronary artery disease Renal failure Prognosis
We thank Ms. Eri Tomita, Ms. Fumie Saito and Ms. Mineko Naganawa for their clerical assistance. MINICON study group: Principal investigators: Yuji Ikari, MD, PhD (Tokai University School of Medicine, Isehara Japan). MINICON study investigators: Mamoru Nanasato, MD, Yasuko Kato (Cardiovascular Center, Nagoya Daini Red Cross Hospital, Japan), Hiroshi Umetsu, MD (Seirei Fuji Hospital, Japan), Katsuaki Sakai, MD, Yuji Ikari, MD, PhD, (Tokai University School of Medicine, Isehara, Japan), Masaaki Okutsu, MD, Takashi Kitao, MD (Nozaki Tokushukai hospital, Japan), Tomonobu Takikawa, MD, Takuya Sumi, MD (Kasugai Municipal Hospital, Japan), Satoru Sumitsuji, MD, Kensuke Yokoi, MD (Osaka University Graduate School of Medicine, Japan), Kenji Sadamatsu, MD, Yasuaki Koga, MD (Saga-ken Medical Centre Koseikan, Japan), Masanori Takada, MD (Medical corporation Kawasaki hospital, Japan), Nobuyuki Ogasawara, MD, Shinji Hasegawa, MD, (Japan Community Healthcare Organization Osaka Hospital, Japan), Kanichi Otowa, MD (Municipal Tsuruga Hospital, Japan), Hiroshi Asano MD, PhD (National Hospital Organization Kyoto Medical Center, Japan), Mitsuru Abe, MD (National Hospital Organization Kyoto Medical Center, Japan), Kohei Wakabayashi, MD, Masahiro Sasai, MD (Showa University Fujigaoka Hospital, Japan).
Daiichi Sankyo Company, Limited (Tokyo, Japan).
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